Numerous and overly detailed medication alerts are a common source of frustration across electronic medical record systems, researchers suggested.

Action Points

A VA point-of-care study found that medication alerts generated by the electronic medical record system were frequently frustrating to prescribers because they were numerous, contained extra information, and did not apply to the patient.

Note that the single center study highlighted the likelihood of "alert fatigue" given the high number of alerts during the prescribing process.

Medication alerts in electronic medical record systems (EMR) need improvement to avoid what has been called "alert fatigue," researchers suggested.

Some alerts don't give enough information and others contradict common clinical practice, according to Alissa Russ, PhD, of the Richard L. Roudebush VA Medical Center in Indianapolis, and colleagues.

One result may be that practitioners distrust the value of the system, Russ and colleagues argued in the April issue of the International Journal of Medical Informatics.

For this empiric study, the researchers followed 30 doctors, nurse practitioners and pharmacists as they treated 146 patients in a variety of outpatient clinics at the Indianapolis VA center from August 2008 to August 2009.

During the observation periods, 320 medication alerts were generated by the center's EMR system. The prescribers were observed in situ as they ordered medications for patients and resolved alerts, the authors explained.

The nature of the alerts, and how providers responded to them, allowed Russ and colleagues to identify factors that influence how well the alerts work, including the content of the alert, the pharmaceutical knowledge needed to understand it, and how it is displayed on the computer screen.

Improperly designed alerts, Russ and colleagues noted, may cause prescribers to overlook important alerts for the following reasons:

The system generates too many alerts

The alert provides too much extra information

The alert does not apply to the patient

An example of the latter would be a warning about a drug that the patient has already received, without experiencing side effects or other problems.

Russ and colleagues found that prescribers were sometimes unsure why an alert was appearing, especially in cases where the alert appeared to contradict common clinical practice.

For instance, one alert warned prescribers about duplicate drug classes of antiretrovirals used to treat HIV. But such duplication is both common and, in most cases, required for HIV regimens.

They also found that alert designs were more oriented to the needs and training of pharmacists than to physicians or nurse practitioners, although the latter two groups did most of the prescribing.

The prescribers said they wanted more patient-specific alerts, such as those that are triggered by a patient's lab values, Russ and colleagues reported, but they disliked repetitive or redundant alerts.

The timing of alerts can also be a barrier. In some cases, alerts interrupted the prescribing process and could not be postponed or dealt with later.

On the other hand, there was no way to retrieve alerts that had been dealt with and then had vanished from the screen.

"Too many alerts and overly detailed alerts are a common source of frustration across electronic medical record systems," Russ said in a statement.

"Unless we improve medication alerts so they contain information that users need to make decisions, the problem of alert fatigue will grow as (electronic medical record) systems expand beyond single hospitals and share more data."

The researchers cautioned that the analysis is based on data at a single VA institution so the results may not apply across medical centers, even if the same alert system is used.

The study was supported by the VA Health Services Research and Development Center of Excellence on Implementing Evidence-Based Practice. The journal said the authors had reported no conflicts.

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